NPIMap

Organization Active NPI

Graham Hospital Association

Doing business as Graham Medical Group Elmwood

  • Rural Health Clinic/Center
  • Elmwood, IL
National Provider Identifier
1093288797
Registry record updated Jan 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GRAHAM HOSPITAL ASSOCIATION
Doing business as
Graham Medical Group Elmwood
Practice address
1024 N. Magnolia St.
Elmwood, IL 61529
Phone
(309) 647-0201
Fax
(309) 647-8613
NPI assigned
Jan 4, 2019
Last updated
Jan 4, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Julie Reeder
Title
VP of Finance/Cfo
Phone
(309) 647-5240

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Multi-Specialty Clinic/Center 261QM1300X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1024 N. Magnolia St.
Elmwood, IL 61529

Mailing address

180 S Main St
Canton, IL 61520-2608
Phone (309) 647-0201

Other names 1

  • Graham Medical Group Elmwood Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040510000873 IL Part B Supplier - Clinic/Group Practice 2769375021 Receives reassigned benefits from 139 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Galesburg, IL; Williamsfield, IL; Macomb, IL; Lewistown, IL; Glasford, IL; Farmington, IL; Elmwood, IL; Canton, IL
O20190124000462 IL Part A Provider - Rural Health Clinic 2769375021 Practice locations: Elmwood, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093288797. Details of each certification follow.

Rural health clinic certification: CCN 148603

Legal name
GRAHAM HOSPITAL ASSOCIATION
Doing business as
GRAHAM MEDICAL GROUP ELMWOOD
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 23, 2019
Last certification
Oct 23, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Oct 16, 1905 in IL
Enrollment address
1024 N Magnolia St
Elmwood, IL 61529-9602
Related CCNs
140001

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 14

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2162398Graham Medical Group - Elmwood1024 Magnolia St, Elmwood, IL 61529Certificate of waiverFeb 20, 2027

National Provider Directory

National Provider Directory

Locations

408 S Main St
Lewistown, IL 61542
Phone (309) 547-9700

1630 E Jackson St
Macomb, IL 61455
Phone (309) 647-5240

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Allison Sours Individual Corporate OfficerPresident and Ceo Jan 6, 2026
W-2 Managing EmployeePresident & Ceo Jan 5, 2026
Operational/Managerial ControlPresident & Ceo Jan 5, 2026
William Carlberg Individual Operational/Managerial ControlBoard Member Mar 4, 2019
Kenneth Krock Individual Corporate OfficerVP of Medical Staff Mar 4, 2019
Operational/Managerial ControlBoard Member Mar 4, 2019
Terry Moss Individual Operational/Managerial ControlBoard Member Mar 4, 2019
Janis Blout Individual Operational/Managerial ControlBoard Member Mar 1, 2019
Anne Hollis Individual Corporate DirectorBoard Member Jan 1, 2025
Erin Elizabeth Bailey Individual Corporate DirectorBoard Member Jul 1, 2025
Kevin Meade Individual Operational/Managerial ControlBoard Member Mar 4, 2019
Michael Renner Individual Operational/Managerial ControlBoard Member Mar 4, 2019
Patrick B Renick Individual Corporate OfficerMedical Staff President Mar 4, 2019
Operational/Managerial ControlBoard Member Mar 4, 2019
Sarah Keefer Individual Corporate DirectorBoard Member Jul 1, 2025
Julie Reeder Individual Corporate OfficerVP of Finance/Cfo Mar 6, 2017
W-2 Managing EmployeeVP of Finance/Cfo Mar 6, 2017
Operational/Managerial ControlVP of Finance/Cfo Mar 6, 2017

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1546560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546560000000",
    "number": "1093288797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 S MAIN ST",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615202608",
            "telephone_number": "309-647-0201",
            "fax_number": "309-647-8613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1024 N. MAGNOLIA ST.",
            "city": "ELMWOOD",
            "state": "IL",
            "postal_code": "61529",
            "telephone_number": "309-647-0201",
            "fax_number": "309-647-8613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAHAM HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-04",
        "last_updated": "2019-01-04",
        "status": "A",
        "authorized_official_last_name": "REEDER",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "VP OF FINANCE/CFO",
        "authorized_official_telephone_number": "309-647-5240"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Graham Medical Group Elmwood",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elmwood, IL

Sources for this page

Verify at the official NPI Registry.